WO2006035769A1 - Tracheal cannula - Google Patents

Tracheal cannula Download PDF

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Publication number
WO2006035769A1
WO2006035769A1 PCT/JP2005/017742 JP2005017742W WO2006035769A1 WO 2006035769 A1 WO2006035769 A1 WO 2006035769A1 JP 2005017742 W JP2005017742 W JP 2005017742W WO 2006035769 A1 WO2006035769 A1 WO 2006035769A1
Authority
WO
WIPO (PCT)
Prior art keywords
suction
path
force
trachea
tracheal
Prior art date
Application number
PCT/JP2005/017742
Other languages
French (fr)
Japanese (ja)
Inventor
Shuichi Tokunaga
Makoto Yamamoto
Original Assignee
Koken Co., Ltd.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Koken Co., Ltd. filed Critical Koken Co., Ltd.
Priority to JP2006537752A priority Critical patent/JP4916884B2/en
Priority to US11/664,071 priority patent/US20080257353A1/en
Priority to EP05788397A priority patent/EP1806158A1/en
Publication of WO2006035769A1 publication Critical patent/WO2006035769A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0475—Tracheal tubes having openings in the tube
    • A61M16/0477—Tracheal tubes having openings in the tube with incorporated means for delivering or removing fluids
    • A61M16/0484—Tracheal tubes having openings in the tube with incorporated means for delivering or removing fluids at the distal end
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0486—Multi-lumen tracheal tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/0027—Accessories therefor, e.g. sensors, vibrators, negative pressure pressure meter

Definitions

  • the present invention relates to a tracheal force-yure used to give artificial respiration to a patient, and in particular, proposes a tracheal force-yuree that can effectively suck sputum accumulated in a patient's trachea.
  • the tracheal force-yure that is the subject of the present invention is not limited to the tracheostomy tube that is inserted into the trachea through a hole formed in the trachea of the patient by tracheostomy surgery, but is an artificial respiration that is orally inserted into the trachea. It also includes utility-Yule.
  • Conventional technology Conventional technology
  • the tracheal force-Yule is inserted into the incised trachea, and the trachea force-Yule is communicated with the respiratory tube with extended ventilator force through the adapter part.
  • a technology for artificial respiration using human respirators has been developed! In the trachea-yure, breathing paths for air supply and exhaust are formed. In artificial respiration, sputum that accumulates in the trachea blocks the airway, and its treatment is a challenge.
  • the conventional treatment method for sputum is that the caregiver removes the adapter part of the tracheal force-Eureka, and then inserts a suction catheter into the tracheal force-eurette from the opening (respiratory tube side mouth). Is to suck.
  • this treatment method forced the caregiver to work day and night, increasing the burden on the caregiver.
  • Patent Document 1 passes a suction catheter for sputum suction over the substantially entire length of the side wall (left side wall).
  • a trachea force-Yule with a small-diameter through hole is proposed.
  • a suction catheter is inserted into the through-hole during suction, and the soot collected in the trachea is sucked from the suction port (small opening) formed at the tip of the suction force tail.
  • the suction catheter is composed of a tube with a gentle arc shape with a large radius of curvature (the cross section is elliptical).
  • the position of the sputum suction port in the circumferential direction of the suction catheter is on the opposite side of the trachea side inner wall (180 ° phase position with respect to the trachea side inner wall). It is the chest surface side (see FIGS. 6A and 6B in Patent Document 1).
  • Respiratory tract The trachea side mouth and the trachea side mouth of the through hole are arranged in the same plane orthogonal to the length direction of the respiratory tract (see Fig. 2 of Patent Document 1).
  • a cuff also referred to as a “balloon” that expands and contracts when air is taken in and out is provided on the outer peripheral side of the distal end portion of the tracheal force-yure.
  • Patent Document 1 Japanese Utility Model Publication No. 57-182449
  • the tracheal force-Yule described in Patent Document 1 it is possible to easily treat a fistula in the left bronchus, which previously required skill. This is because the through-hole exists in the side wall of the tracheal force-yure and the tracheal force-yure is generally gently curved.
  • the tracheal force-Yule disclosed in Patent Document 1 can be used to directly suck the phlegm in the trachea without using the suction catheter through the hole and directly using the hole as the hole. .
  • the suction position of the sputum suction port at the distal end is the side opposite to the tracheal side inner wall (curved inner surface) when indwelled.
  • the suction action of the sputum was not started.
  • the timing of inhalation of soot is delayed until a certain amount of soot accumulates in the trachea.
  • this soot cannot be eliminated and smooth breathing may be hindered.
  • An object of the present invention is to provide a tracheal force-yure that can suck a sputum at an early stage after the occurrence of the sputum.
  • Another object of the present invention is to provide a tracheal force-yure that can reduce the remaining amount of soot in the trachea after soot suction.
  • Still another object of the present invention is to provide a tracheal force neuron capable of removing sputum that has entered the respiratory tract.
  • the tracheal force-yure includes a proximal end portion for connecting a respiratory tube extended from an external ventilator force, and a trachea of a patient.
  • a cuff that includes a leading end portion to be inserted, and is provided around the outer peripheral side of the distal end portion so as to be inflated and contracted by air in and out, and is used for air supply and exhaustion between the proximal end portion and the distal end portion.
  • a breathing path is provided, a mouth on the trachea side is formed at the tip of the breathing path, and a suction path for sucking sputum accumulated in the patient's trachea is provided along the breathing path separately from the breathing path.
  • a wall on the tracheal inner wall side of the suction path has a spout suction port in a region between the distal end portion of the suction path and the cuff.
  • the tip of the tracheal force-yure is inserted into the incised trachea, and air is injected into the cuff to inflate it. This closes the gap between the tracheal force-urea and the inner wall of the trachea.
  • connect the respiratory tube with the ventilator force to the base of the tracheal force-Yule.
  • the ventilator feeds and evacuates the patient's trachea through the tracheal force-Yule breathing path.
  • the respiratory tract is in constant communication with the ventilator via the respiratory tract.
  • soot suction device communicated with the soot suction path via the suction tube is operated, so that soot is generated through the soot suction path and suction tube by the negative pressure. Sucked out of the body.
  • a soot suction port is formed in the wall on the tracheal inner wall side of the soot suction path at a portion between the tip of the soot suction path and the cuff.
  • the sputum suction port is not opened perpendicularly to the inner wall of the trachea as in the prior art, but is opened facing the inner wall of the trachea. For this reason, even if the amount of sputum is less than the amount of sputum required when a conventional suction catheter sucks sputum, specifically, the amount of sputum to reach the wall on the tracheal inner wall side of sputum arch I ⁇ It is possible to close the entire suction port. As a result, sputum in the trachea can be sucked at an early stage, and the response of tracheal force-yure to sputum generation can be improved.
  • the present inventors have found for the first time that the advantageous effects described above can be achieved by forming a sputum suction port on the wall on the tracheal inner wall side of the sputum suction path so as to face the tracheal inner wall. It has been.
  • the suction port in the suction path of the sputum is arranged on the cuff side with respect to the tracheal side port provided at the distal end portion of the respiratory path. It is. In this case, there is a mouth-forming wall on the trachea side of the respiratory tract ahead of the tracheal force-Yule from the sputum suction port. For this reason, when sputum is sucked, the sputum collected in the trachea. If the sputum touches the formation wall of the mouth on the trachea side before the suction port is almost completely closed, the spider spreads along the wall surface.
  • part of the soot also moves in the direction of the soot suction port.
  • the ⁇ suction port is blocked. It becomes easy to be done.
  • the soot can be reliably suctioned and the soot in the trachea can be sucked in early. In other words, the response of tracheal force-yure to the occurrence of sputum can be improved.
  • the septum located between the respiratory path and the suction path is provided with another sputum suction port that communicates both of them.
  • the soot suction port that directly communicates the soot suction path and the trachea is sucked into the trachea inner wall and sucks soot (empty suction)
  • the trachea inner wall is connected to the soot suction port at the tip of this force neuron body. Part will not stick. This is because there is another sputum suction port that acts as a relief valve in the septum on the breathing path side of the sputum suction path.
  • the soot suction port formed in the partition wall is the inner wall of the trachea in the suction path.
  • soot flows into the suction path from the soot suction port formed on the side wall, it is blocked by the formation of a soot film in the suction path.
  • the suction force of the soot suction loci on the inner wall of the trachea is not reduced by forming the soot suction port in the partition wall.
  • soot may flow into the respiratory tract of the tracheal force neure and hinder smooth breathing. Since the suction is performed by the septum-side sputum suction port at the tip of the suction path, even if the sputum flows into the breathing path, it can be removed quickly, and there is virtually no risk of hindering smooth breathing. None.
  • the tip of the suction path of the sputum may be configured to be sealed, or may be configured to be open and communicated with the trachea.
  • a part of the partition wall between the breathing path and the suction path is terminated at the base end side from the distal end of the force-yure body to form a communication space in which the distal ends of the breathing path and the suction path communicate with each other.
  • the communication space can be configured to be able to communicate with the trachea.
  • FIG. 1 is a perspective view showing an artificial respiration system to which the tracheal force-ule of the present invention is applied.
  • FIGS. 2a and 2b are schematic views respectively showing a longitudinal section and a transverse section of the tracheal force-yure according to the first embodiment of the present invention.
  • FIG. 3 is a schematic view similar to FIG. 2b, showing a modified example of the tracheal force neuule according to the first embodiment.
  • FIGS. 4a and 4b are schematic views showing a longitudinal section and a transverse section of a tracheal force-yure according to a second embodiment of the present invention, respectively.
  • FIGS. 5a, 5b, 5c and 5d are schematic diagrams showing the tracheal force-yure sputum suction operation according to the second embodiment, respectively.
  • FIG. 6 is a schematic diagram showing a sputum suction operation of a tracheal force neuron according to a third embodiment of the present invention.
  • FIG. 7 is a schematic diagram showing the sputum suction operation of the tracheal force neurale according to the fourth embodiment of the present invention. is there.
  • FIG. 8 is a schematic view showing a sputum suction operation of a tracheal force neuron according to a fifth embodiment of the present invention.
  • reference numeral 10 represents the whole artificial respiration system to which the tracheal force-urere 14 according to the first embodiment of the present invention is applied.
  • the artificial respiration system 10 includes a ventilator 12 to which a respiratory tube 11 for supplying and exhausting air is connected and connected, a tracheal force-urele 14 inserted into a trachea 13 incised by a patient, and a respiratory tube 13 accumulated in the trachea 13.
  • a suction tube 15 is connected to a suction tube 15 for sucking out the soot, and a soot collection bottle 17 is provided.
  • the artificial respiration system 10 includes a control unit (control box) 18 in which a sequencer, a timer, and the like are arranged, and adjusts the suction pressure by the heel suction device 16 according to the internal pressure of the suction tube 15 to adjust the suction device. This controls the amount of inflow to 16.
  • a control unit control box 18 in which a sequencer, a timer, and the like are arranged, and adjusts the suction pressure by the heel suction device 16 according to the internal pressure of the suction tube 15 to adjust the suction device. This controls the amount of inflow to 16.
  • the ventilator 12 has a known configuration in which a built-in aspirator and a compressor are alternately operated at regular intervals to ensure patient respiration.
  • the respiratory tube 11 communicates the air supply / exhaust port of the ventilator 12 with the mount (joint) 20 attached to the proximal end of the tracheal force-urele 14.
  • An exhalation valve 21 is provided in the middle of the respiratory tube 11.
  • Tracheal force-Force of Yule 14-Yule body 14A is composed of a plastic tube of a predetermined length curved in a substantially J-shape, and has a hole formed in the trachea 13 of the patient by tracheostomy surgery. It is inserted into the trachea 13 through.
  • the force neuron body 14A has a circular cross section with an inner diameter of, for example, 8 to 12 mm, has a respiratory passage 14a formed therein, and the tip opens into the patient's trachea.
  • a cuff 32 that is expanded and contracted by taking in and out air is arranged in an annular shape in close contact with the outer periphery of the main body 14A.
  • Cuff 32 is an annular balloon made of a synthetic resin sheet.
  • a thin tube 32a made of synthetic resin that injects air into the cuff 32 is fixed to the outer peripheral side of the force-yure body 14A.
  • a small cylindrical adapter 33 with a valve is provided at the proximal end of the thin tube 32a.
  • the internal space of the substantially cylindrical force-urele body 14A includes the above-described respiratory path 14a and the suction path of the sputum disposed on one side of the respiratory path 14a.
  • 14b is divided by the partition 140 and provided separately.
  • the inside of the force neuron main body 14A is separated by the partition wall 140 into a breathing path 14a having a large cross-sectional area and a substantially half-moon shaped suction path 14b having a smaller cross-sectional area.
  • the position where the sputum suction path 14b is formed on the outer periphery of the respiratory path 14a is a portion of the outer wall of the force-urele body 14A curved in a substantially J shape that is located on the opposite side of the center of curvature.
  • the suction path 14b of the heel is placed along the J-shaped curve at the lower (back) side of the patient. It is what is done. It is also possible to increase the thickness of the tube wall of the force-yure body 14A and form a soot suction path 14b in the tube wall.
  • the breathing path side of the tube wall functions as a partition between the breathing path 14a and the suction path 14b.
  • an elliptical spear suction port 14c is formed on the lower surface of the tip of the spear suction path 14b.
  • a trachea side mouth 14d is formed at the tip of the respiratory path 14a.
  • the inside of the trachea communicates with the respiratory tube 11 of the ventilator 12 through the mouth 14d.
  • the tip of the soot suction path 14b is sealed.
  • the soot suction path 14b performs soot suction through the soot suction port 14c at the tip.
  • the shape of the spout suction port 14c is not limited to an ellipse, and may be, for example, a slit having a predetermined width and length.
  • the distal end portion of the suction tube 15 extending from the suction suction device 16 bypassing the mount 20 is communicated with the proximal end portion of the trachea force—the force of the urea 14 and the urea body 14A.
  • the outer diameter of the suction tube 15 is 4 mm, for example.
  • the sputum suction passage 14b is a passage that has a flat partition wall 140 for partitioning with the respiratory passage 14a and a half-moon shape whose cross section perpendicular to the length direction is illustrated in FIG. 2b.
  • Figure 3 shows a modification in which the cross-sectional shape of the suction path 14b is circular.
  • the cross-sectional shape of the suction path 14b may be other than the above, for example, an ellipse.
  • the suction path 14b is formed on the curved convex side along the curve of the force-urele main body 14A.
  • This curved convex side becomes close to or close to the inner wall of the tracheal floor when attached to the trachea of a patient lying on his back, and the opposite concave side separates the inner wall force of the tracheal floor.
  • the respiratory tract The cross-sectional area of 14a is larger than that of the suction channel 14b. This allows the patient to breathe comfortably.
  • the suction tube 15 is a flexible elastic thin elastic tube.
  • a short branch pipe 30 used for detecting suction pressure by the soot suction device 16 is connected to the upstream side (tracheal force-Yure 14 side) of the middle portion of the suction tube 15 in the length direction.
  • the branch pipe 30 communicates with the pressure sensor 31 at its tip (upper end in Fig. 1).
  • the pressure sensor 31 can measure the internal pressure of the suction path 14b (that is, the suction pressure of soot in the suction path 14b).
  • the soot suction unit 16 sucks out the soot accumulated in the trachea 13 through the soot suction path 14b and the suction tube 15 due to the negative pressure generated therein, and collects it in the collection bottle 17.
  • the sputum suction device 16 includes an appropriate pump, for example, a tube pump 16A.
  • the tube pump 16A has three pressure rollers that locally press and close a suction tube 15 made of a synthetic resin having a predetermined elastic force and projecting at positions spaced apart in the circumferential direction on the outer periphery.
  • the outer peripheral surface force of the rotor is also set apart by a predetermined distance, and the surface facing the rotor is configured as a tube pressing surface curved parallel to the outer peripheral surface of the rotor, and the rotor is rotated.
  • the rotating means of the rotor consists of an electric motor 52, which rotates the rotor along the tube pressing surface of the pressing guide.
  • the standard feed rate (pumping speed) for soot by tube pump 16A is 50 to 200cc / sec.
  • the control unit 18 controls the suction operation of the soot as follows.
  • the tube pump 16A is operated at a preset value (normal suction pressure during soot suction), and the detection value detected by the pressure sensor 31 becomes higher than the set value.
  • an operation command is issued to the tube pump 16A to increase the pump output for a predetermined time.
  • the tube pump 16A is always operated during normal operation of the soot suction device 16, and if an abnormal condition such as clogging occurs in the suction tube 15, the output of the tube pump 16A is increased to deal with it. is there.
  • an auxiliary pump controlled by the control unit 18, such as a diaphragm pump, is provided in addition to the soot suction device 16.
  • the tracheal force the force of the urea 14
  • the tip of the urea body 14A is inserted into the trachea 13 of the incised patient.
  • the force curved with a predetermined curvature the curved convex portion of the Eurel main body 14A is on the lower side and faces the inner wall of the trachea.
  • the gap between the peripheral wall of the force-yure body 14A and the inner wall of the trachea is closed by the cuff 32.
  • the respiratory tube 11 extended from the ventilator 12 is communicated with the proximal end of the force-yure body 14A.
  • the patient's breathing that is, the air supply and exhaust to the patient's trachea 13 using the ventilator 12 is performed through the respiratory tube 11 and the mount 20 as before, and the respiratory path 14a in the force-urere body 14A. Done through.
  • the tube pump 16A communicated with the sputum suction path 14b is operated via the suction tube 15.
  • soot is sucked into the suction path 14b through the suction port 14c and sucked out of the body through the suction path 14b and the suction tube 15 due to the negative pressure generated in the pump 16A.
  • the respiratory path 14a is always in communication with the ventilator 12, respiration is ensured even during sputum suction. The soot suction action by tube pump 16A will be described later.
  • the tip of the soot suction path 14b is closed.
  • the sputum suction port 14c is arranged on the cuff 32 side of the trachea side port 14d of the respiratory path 14a. That is, the sputum suction port 14c is not opened perpendicularly to the tracheal inner wall as in the prior art, but is opened in parallel with the tracheal inner wall, and the tracheal side port 14d in the respiratory tract 14a.
  • the formation wall is exposed to the front side of the trachea-urele 14 rather than the sputum suction port 14c.
  • soot suction port 14c of the trachea-yure 14 When the soot collected in the trachea 13 contacts the formation wall of the tracheal side mouth 14d even before it almost completely closes the soot suction port 14c of the trachea-yure 14, It spreads along the wall. Of course, part of the soot also moves in the direction of the soot suction port 14c. As a result, the sputum suction port 14c is more easily clogged than the conventional tracheal force-Yure. As a result, even if the amount of soot generated in the trachea 13 is relatively small, soot can be sucked accurately even if the conventional technology cannot practically suck the soot. That is, according to the present invention, the soot in the trachea 13 can be sucked at an early stage, and the response of the tracheal force nucleus 14 to the generation of soot is enhanced. You can
  • the blocking position on the suction tube 15 gradually shifts to the soot discharge side, and negative pressure is generated on the suction side of the suction tube 15 so that the soot in the trachea 13 is removed from the soot suction port 14c and the suction path.
  • the soot in the suction tube 15 is gradually pumped to the discharge side and finally discharged from the suction tube 15.
  • the soot suction device 16 can be obtained with a simple and low-cost structure.
  • the soot suction port 14c of the soot suction path 14b is not blocked by soot or the like, the internal pressure of the tube does not increase.
  • the tube pump is not used for the first time.
  • the suction pressure by 16A starts to rise. Therefore, if the air in the cuff 32 escapes and the suction port 14c of the suction tube 15 placed in the trachea 13 comes into contact with the inner wall of the trachea, the suction pressure does not increase. It is not sucked into the suction channel 14b and there is virtually no risk of damaging the inner wall of the trachea.
  • the pressure sensor 31 can reliably and immediately detect the presence or absence of soot.
  • FIGS. 4a and 4b show the tracheal force-yure according to the second embodiment of the present invention.
  • the tracheal force-Yule according to this example has basically the same configuration as that of the first example described above, and the difference is that the side opposite to the sputum suction port 14c in the sputum suction path 14b is the same.
  • Another soot suction port 14e of approximately the same size is formed on the partition wall 140 in a portion corresponding to the upper surface. It is a point.
  • the sputum suction port 14e opens and communicates with the distal end of the respiratory path 14a in the tracheal force-urere 14.
  • the tube pump 16A When soot accumulates in the trachea 13 of the patient, the tube pump 16A is operated as in the first embodiment. As a result, the negative pressure generated in the pump 16A causes the soot to be sucked into the suction path 14b from the sputum suction port 14c, and then sucked out of the body through the suction path 14b and the suction tube 15. The soot is sucked into the suction path 14b from the soot suction ports 14c and 14e. In other words, not only the soot on the inner wall of the trachea 13 but also the soot in the force-yure main body 14A is sucked simultaneously.
  • FIG. 5a shows a state where no ph is present in the trachea.
  • the lower soot suction port 14c is in close contact with the inner wall of the trachea, but since the upper soot suction port 14e is open, the lower soot suction port 14c is attracted to the tracheal inner wall and completely removed. The suction port 14c is not blocked, and the inner wall of the trachea is not sucked from the suction port 14c.
  • Figures 5b and 5c show the operation when ph is present in the trachea. In this way, soot is sucked into the suction path 14b from the soot suction port 14c. At this time, the upper soot suction port 14e is covered with a thin film.
  • Fig. 5d illustrates the aspiration action when sputum enters the respiratory path 14a of the tracheal force-Yule 14. As shown in Fig. 5d, sputum in the respiratory path 14a is sucked from the upper sputum suction port 14e. At this time, since the respiratory path 14a is in constant communication with the ventilator 12, respiration is secured even during sputum suction.
  • this other soot suction port 14e plays the same role as the relief valve, and even if the soot suction port 14c on the inner wall of the trachea is closely attached to the inner wall of the trachea, As a result, excessive negative pressure does not act in another sputum suction port 14e.
  • sputum suction port 14e formed in septum 140 on the breathing path 14a side of sputum suction path 14b is used as a respiratory path by ventilator 12 when sputum flows into suction path 14b. Induced by the air flow in 14a, a soot film is stretched along the inner peripheral surface of the tip of the suction channel 14b. It is blocked by (occurs). As a result, there is virtually no fear that the suction force of the sputum will be greatly reduced by forming the sputum suction port 14e on the breathing path 14a side wall of the sputum suction path 14b (Figs. 5b and 5c). Such advantageous effects have been discovered for the first time by the present inventors.
  • FIG. 6 shows a third embodiment of the tracheal force-yure according to the present invention.
  • the tip of the sputum suction path 14b of the tracheal force-Yure 14 is opened. Therefore, the respiratory path 14a and the suction path 14b defined by the septum 140, which is shorter in length than the force-yure body 14A (that is, terminated by cutting off the front end portion), are the sputum suction path 14b. It communicates with the opening at the tip of the. This opening corresponds to the sputum suction path 14e in the second embodiment, and sputum existing in the breathing path of the force-yuree main body can also be sucked through this opening.
  • a slit having a predetermined width may be formed at the tip of the partition 140 by a predetermined length. When the tracheal force-Yule is attached, this slit allows the upper respiratory path 14a to communicate with the lower sputum suction path 14b.
  • the suction of the soot from the lower soot suction port 14c is the same as that of the above embodiment, but the upper soot suction port ( In the second embodiment, the soot suction port 14e) is notched and opened, or a slit is formed at the end of the bulkhead.
  • the sputum in the respiratory path 14a is sucked from the portion communicating with the mouth 14d). Note that it is easier to make a slit at the tip of the bulkhead than to cut it out.
  • Other configurations and operations are the same as those in the above-described embodiment.
  • FIG. 7 shows a fourth embodiment of the tracheal force-yure according to the present invention.
  • the tip of the trachea force-yure 14 sputum suction path 14b (force-a part of the bottom of the yule body 14A) is cut away and opened.
  • the respiratory path 14a and the suction path 14b defined by the septum 140 communicate with each other through a sputum suction port 14e formed at the distal end of the septum 140.
  • sputum suction path 14b The tip of the tube opens or opens below the tip of the septum 140 and communicates with the trachea.
  • This opening or opening 14c ′ corresponds to the soot suction path 14c in the above-described embodiment, and the soot existing at the bottom of the trachea outside the force-urele main body 14A is sucked through this opening 14c ′. be able to.
  • the distal end opening 14d of the respiratory path 14a is located closer to the distal end side in the length direction of the force-urel body 14A than the opening 14c '.
  • soot suction from the upper soot suction opening 14e is the same as that of the above embodiment, but the lower soot suction opening is Since 14c 'is greatly cut away and opened, soot in the trachea is aspirated from this open part (ie, the part communicating with the trachea located outside the tip of the force-urele body 14A) It will be.
  • Other configurations and operations are the same as those in the above-described embodiment.
  • FIG. 8 shows a fifth embodiment of the tracheal force-yure according to the present invention.
  • the tip of the sputum suction path 14b of the tracheal force neurale 14 is opened (opening 14g) flush with the tip opening 14d of the respiratory path 14a.
  • the respiratory path 14a and the suction path 14b defined by the septum 140 communicate with each other through a sputum suction port 14e formed at the tip of the septum 140.
  • the tip of the sputum suction path 14b communicates with the trachea through the opening 14g.
  • a spear suction port 14c similar to that in the above-described embodiment is formed on the tip side of the cuff 32 of the force-urele main body 14A. Therefore, if the suction passage 14b of the sputum is made negative by the operation of the suction device 16, sputum in the respiratory passage 14a can be sucked from the sputum suction port 14e, and force-can be applied through the opening 14g and the sputum suction port 14c. Can absorb soot present at the bottom of the trachea outside the Eure body 14A.
  • the soot suction from the upper soot suction opening 14e is the same as that of the above embodiment, but the lower soot suction opening In addition to 14c, a leading end opening 14g is provided, so that the sputum in the trachea is also sucked from the open portion 14g, and the sputum in the trachea can be quickly sucked.
  • Other configurations and operations are the same as those in the above-described embodiment.
  • the tracheal force neuule is not limited to a tracheostomy tube inserted into the trachea through a hole formed in the tracheotomy of a patient by tracheostomy surgery, but also to a force for artificial respiration inserted into the trachea-Yule. It goes without saying that is equally applicable.

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Abstract

A tracheal cannula has an air supply and discharge breathing path between its base end to which a breathing tube extended from an external respirator is connected and its head end that is inserted in the trachea of a patient, and the head of the breathing path has a trachea side opening. A suction path for sucking phlegm collected in the trachea of the patient is provided separately from the breathing path, along the breathing path. That wall of the suction path which is on the trachea inner wall side has a phlegm suction opening facing the trachea inner wall, the phlegm suction opening being located in a region between the head of the suction path and a cuff.

Description

明 細 書  Specification
気管力ニューレ  Tracheal force
技術分野  Technical field
[0001] 本発明は，患者に人工呼吸を施すために使用する気管力-ユーレに関するもので あり，特に，患者の気管内に溜まった痰を効果的に吸引可能とした気管力-ユーレを 提案するものである。なお，本発明の対象とする気管力-ユーレは，気管切開手術に より患者の気管途中に形成された孔を通して気管に挿入される気管切開チューブの みならず，気管に経口挿入される人工呼吸用力-ユーレをも包含するものである。 従来技術  [0001] The present invention relates to a tracheal force-yure used to give artificial respiration to a patient, and in particular, proposes a tracheal force-yuree that can effectively suck sputum accumulated in a patient's trachea. To do. It should be noted that the tracheal force-yure that is the subject of the present invention is not limited to the tracheostomy tube that is inserted into the trachea through a hole formed in the trachea of the patient by tracheostomy surgery, but is an artificial respiration that is orally inserted into the trachea. It also includes utility-Yule. Conventional technology
[0002] 患者の呼吸を確保するため，切開された気管に気管力-ユーレを挿入し，気管力- ユーレに，アダプタ部を介して，人工呼吸器力も延びた呼吸管を連通することで，人 ェ呼吸器を利用した人工呼吸を施す技術が開発されて!、る。気管力-ユーレ内には ,送気及び排気用の呼吸路が形成されている。人工呼吸では，気管に溜まった痰が 気道を塞ぐため，その処置が課題となる。従来より汎用されている痰の処理方法は， 介護者が気管力-ユーレカもアダプタ部を外し，その後，開口部（呼吸管側の口）か ら気管力-ユーレに吸引カテーテルを挿入し，痰を吸引するものである。しかしながら ,この処置方法では，介護者に昼夜を問わぬ労働を強いてしまい，介護者への負担 が大きくなつていた。  [0002] In order to ensure the patient's breathing, the tracheal force-Yule is inserted into the incised trachea, and the trachea force-Yule is communicated with the respiratory tube with extended ventilator force through the adapter part. A technology for artificial respiration using human respirators has been developed! In the trachea-yure, breathing paths for air supply and exhaust are formed. In artificial respiration, sputum that accumulates in the trachea blocks the airway, and its treatment is a challenge. The conventional treatment method for sputum is that the caregiver removes the adapter part of the tracheal force-Eureka, and then inserts a suction catheter into the tracheal force-eurette from the opening (respiratory tube side mouth). Is to suck. However, this treatment method forced the caregiver to work day and night, increasing the burden on the caregiver.
[0003] このような問題点を解消する技術として，例えば実開昭 57-182449号公報 (特許文 献 1)は，側壁 (左側壁）にその略全長にわたって，痰吸引用の吸引カテーテルを通 す小径の通し孔が形成された気管力-ユーレを提案している。この提案によれば，痰 吸引時，通し孔に吸引カテーテルを挿入し，気管内に溜まった痰を，吸引力テーテ ルの先端部に形成した痰吸引口（小さな開口）から吸引する。吸引カテーテルは，全 体視して，曲率半径が大きい緩やかな円弧形状を呈するチューブ (断面は楕円形） で構成される。この場合，痰吸引口の吸引カテーテルの周方向における形成位置は ,気管側内壁とは反対側 (気管側内壁に対して 180° の位相位置)であり，具体的に は仰向けに寝た患者の胸表面側である（特許文献 1の図 6A, 6B図参照)。呼吸路の 気管側の口と上記通し孔の気管側の口とは，呼吸路の長さ方向に直交した同じ平面 内に配置されている (特許文献 1の図 2参照)。また，気管力-ユーレの先端部の外周 側には，空気の出し入れで膨縮するカフ（「バルーン」とも称する。）が周設されている 特許文献 1：実開昭 57-182449号公報 [0003] As a technique for solving such a problem, for example, Japanese Utility Model Publication No. 57-182449 (Patent Document 1) passes a suction catheter for sputum suction over the substantially entire length of the side wall (left side wall). A trachea force-Yule with a small-diameter through hole is proposed. According to this proposal, a suction catheter is inserted into the through-hole during suction, and the soot collected in the trachea is sucked from the suction port (small opening) formed at the tip of the suction force tail. The suction catheter is composed of a tube with a gentle arc shape with a large radius of curvature (the cross section is elliptical). In this case, the position of the sputum suction port in the circumferential direction of the suction catheter is on the opposite side of the trachea side inner wall (180 ° phase position with respect to the trachea side inner wall). It is the chest surface side (see FIGS. 6A and 6B in Patent Document 1). Respiratory tract The trachea side mouth and the trachea side mouth of the through hole are arranged in the same plane orthogonal to the length direction of the respiratory tract (see Fig. 2 of Patent Document 1). Further, a cuff (also referred to as a “balloon”) that expands and contracts when air is taken in and out is provided on the outer peripheral side of the distal end portion of the tracheal force-yure. Patent Document 1: Japanese Utility Model Publication No. 57-182449
[0004] 特許文献 1に係る気管力-ユーレの使用時には，先ず，切開された気管に気管力- ユーレの先端部を挿入し，カフに空気を注入してこれを膨らませることにより，気管力 ニューレと気管内壁との隙間を閉塞する。その後，気管力-ユーレの基端部に，人工 呼吸器力 延出された呼吸管を連通させる。痰吸引時には，気管力-ユーレの側壁 の通し孔に吸引カテーテルを挿入し，気管内に溜まった痰を吸引する。その際，特 許文献 1に記載の気管力-ユーレを使用することで，従前までは熟練を要していた左 気管支内の痰の処置を容易に行うことができる。これは，通し孔が気管力-ユーレの 側壁に存在し，かつ気管力-ユーレが全体的に緩やかに湾曲しているためである。 なお，特許文献 1に開示した気管力-ユーレは，吸引カテーテルを通し孔に通さず， 直接，通し孔を痰吸弓 I孔として気管内の痰を吸弓 Iする使 ヽ方も可能である。  [0004] When using the tracheal force-yure according to Patent Document 1, first, the end of the tracheal force-yuree is inserted into the incised trachea, and air is injected into the cuff to inflate it. The gap between the neulet and the inner wall of the trachea is closed. Then, the respiratory tube with the ventilator force extended is connected to the proximal end of the tracheal force-Yule. When sucking sputum, insert a suction catheter into the tracheal force-side wall of the Yure and suck the sputum accumulated in the trachea. At that time, by using the tracheal force-Yule described in Patent Document 1, it is possible to easily treat a fistula in the left bronchus, which previously required skill. This is because the through-hole exists in the side wall of the tracheal force-yure and the tracheal force-yure is generally gently curved. In addition, the tracheal force-Yule disclosed in Patent Document 1 can be used to directly suck the phlegm in the trachea without using the suction catheter through the hole and directly using the hole as the hole. .
[0005] し力しながら，特許文献 1に提案されている気管力-ユーレにあっては，次の問題点 があった。すなわち，  [0005] However, with the tracheal force-Yule proposed in Patent Document 1, there were the following problems. That is,
(1) 仮に，吸引カテーテルを通し孔に通さず，直接，通し孔を痰吸引孔として気管 内の痰を吸引した場合には，痰の吸引時期が遅延する。これは，通し孔の気管側の 口（痰吸引口）力 呼吸路の気管側の口と同じ平面（断面）内に配置されていることに 起因するものである。すなわち，通し孔の気管側の口を痰が略完全に塞がなければ ,ほとんど気道や肺の内部空気を吸い出すだけで，実質的な痰の吸引作用は開始さ れないからである。  (1) If the suction catheter is not passed through the through-hole, and the sputum in the trachea is sucked directly using the through-hole as a sputum suction hole, the sputum suction timing is delayed. This is because the tracheal side mouth (vagin suction port) force of the through hole is located in the same plane (cross section) as the tracheal side mouth of the respiratory tract. In other words, if the sputum does not almost completely block the trachea-side mouth of the through-hole, the air is only sucked out from the airways and lungs, and the substantial sputum suction action is not started.
(2) また，この吸引カテーテルによれば，先端の痰吸引口の形成位置は，留置さ れた場合はその気管側内壁とは反対側 (湾曲した内側面)であるため，吸引力テーテ ルのうち，気管内に挿入された先端部を略完全に痰が塞がなければ，痰の吸引作用 は開始されな力つた。その結果，気管内に一定量の痰が溜まるまで，痰の吸引開始 の時期が遅延する。 (3) さらに，人工呼吸器による排気時に，気管力-ユーレの呼吸路に痰の一部が 流れ込んだ場合，この流れ込んだ痰を排除することができず，円滑な呼吸を妨げる おそれがあった。 発明の開示 (2) In addition, according to this suction catheter, the suction position of the sputum suction port at the distal end is the side opposite to the tracheal side inner wall (curved inner surface) when indwelled. Of these, if the tip inserted into the trachea was not completely closed by the fistula, the suction action of the sputum was not started. As a result, the timing of inhalation of soot is delayed until a certain amount of soot accumulates in the trachea. (3) In addition, when a part of the soot flows into the tracheal force-Yule breathing path when ventilating with a ventilator, this soot cannot be eliminated and smooth breathing may be hindered. . Disclosure of the invention
[0006] 本発明の目的は，痰の発生後，早期に痰を吸引することができる気管力-ユーレを 提供することにある。  [0006] An object of the present invention is to provide a tracheal force-yure that can suck a sputum at an early stage after the occurrence of the sputum.
[0007] 本発明の他の目的は，痰吸引後における気管内での痰の残量を低減することがで きる気管力-ユーレを提供することにある。  [0007] Another object of the present invention is to provide a tracheal force-yure that can reduce the remaining amount of soot in the trachea after soot suction.
[0008] 本発明の更に他の目的は，呼吸路に入り込んだ痰を除去することができる気管力 ニューレを提供することにある。  [0008] Still another object of the present invention is to provide a tracheal force neuron capable of removing sputum that has entered the respiratory tract.
[0009] これらの目的を達成するため，本発明に係る気管力-ユーレは，外部の人工呼吸 器力ゝら延出された呼吸管を接続するための基端部と，患者の気管内に挿入される先 端部とを具え，該先端部の外周側に空気の出し入れによって膨縮されるカフが周設 され，前記基端部と前記先端部との間に送気用及び排気用の呼吸路が設けられ，該 呼吸路の先端部に気管側の口が形成され，患者の気管内に溜まった痰を吸引する ための吸引路が前記呼吸路とは別に該呼吸路に沿って設けられ，該吸引路の気管 内壁側の壁が，該吸引路の先端部と前記カフとの間の領域で痰の吸引口を有するこ とを特徴とするものである。  [0009] In order to achieve these objects, the tracheal force-yure according to the present invention includes a proximal end portion for connecting a respiratory tube extended from an external ventilator force, and a trachea of a patient. A cuff that includes a leading end portion to be inserted, and is provided around the outer peripheral side of the distal end portion so as to be inflated and contracted by air in and out, and is used for air supply and exhaustion between the proximal end portion and the distal end portion. A breathing path is provided, a mouth on the trachea side is formed at the tip of the breathing path, and a suction path for sucking sputum accumulated in the patient's trachea is provided along the breathing path separately from the breathing path. In addition, a wall on the tracheal inner wall side of the suction path has a spout suction port in a region between the distal end portion of the suction path and the cuff.
[0010] 上述した構成の気管力-ユーレによれば，先ず，切開された気管に気管力-ユーレ の先部を挿入し，カフに空気を注入してこれを膨らませる。これにより，気管力-ユー レと気管内壁との隙間が閉塞される。その後，気管力-ユーレの元部に，人工呼吸器 力もの呼吸管を連通させる。人工呼吸器による患者の気管への送気および排気は， 気管力-ユーレの呼吸路を通して行われる。呼吸路は，呼吸管を介して人工呼吸器 と常時連通されている。一方，気管内に痰が溜まった場合には，吸引チューブを介し て痰の吸引路と連通された痰吸引器を作動させることで，その負圧力により，痰の吸 引路及び吸引チューブを通して痰が体外に吸い出される。その際，呼吸路は人工呼 吸器と常時連通されているため，痰の吸引中でも呼吸は確保される。 [0011] このとき，痰の吸引路における気管内壁側の壁には，その痰の吸引路の先端とカフ との間の部分に痰吸引口が形成されている。すなわち，痰吸引口は，従来のように気 管内壁に直交して開口されているのではなく，気管内壁と対峠して開口されている。 そのため，従来の吸引カテーテルが痰を吸引する際に必要とした痰の量よりも少ない 量，具体的には痰吸弓 I路の気管内壁側の壁面に達する程度の痰の量であっても， 痰吸引口の略全体を閉塞することが可能となる。その結果，気管内の痰を早期に吸 引することができ，痰の発生に対する気管力-ユーレの応答性を高めることができる。 痰吸引路の気管内壁側の壁に，気管内壁と対峠させて痰吸引口を形成することによ り，上述したごとき有利な効果が達成されることは，本発明者らによって始めて知見さ れたものである。 [0010] According to the tracheal force-yure having the above-described configuration, first, the tip of the tracheal force-yure is inserted into the incised trachea, and air is injected into the cuff to inflate it. This closes the gap between the tracheal force-urea and the inner wall of the trachea. After that, connect the respiratory tube with the ventilator force to the base of the tracheal force-Yule. The ventilator feeds and evacuates the patient's trachea through the tracheal force-Yule breathing path. The respiratory tract is in constant communication with the ventilator via the respiratory tract. On the other hand, if soot accumulates in the trachea, the soot suction device communicated with the soot suction path via the suction tube is operated, so that soot is generated through the soot suction path and suction tube by the negative pressure. Sucked out of the body. At that time, since the respiratory path is always in communication with the artificial inhaler, respiration is ensured even during sputum suction. [0011] At this time, a soot suction port is formed in the wall on the tracheal inner wall side of the soot suction path at a portion between the tip of the soot suction path and the cuff. In other words, the sputum suction port is not opened perpendicularly to the inner wall of the trachea as in the prior art, but is opened facing the inner wall of the trachea. For this reason, even if the amount of sputum is less than the amount of sputum required when a conventional suction catheter sucks sputum, specifically, the amount of sputum to reach the wall on the tracheal inner wall side of sputum arch I略 It is possible to close the entire suction port. As a result, sputum in the trachea can be sucked at an early stage, and the response of tracheal force-yure to sputum generation can be improved. The present inventors have found for the first time that the advantageous effects described above can be achieved by forming a sputum suction port on the wall on the tracheal inner wall side of the sputum suction path so as to face the tracheal inner wall. It has been.
[0012] 本発明に係る気管力-ユーレにおいて，痰の吸引路における吸引口は，呼吸路の 先端部に設けられた気管側の口よりもカフ側に配置されている構成とするのが好適 である。この場合，痰吸引口より気管力-ユーレの先方に，呼吸路における気管側の 口の形成壁が存在することになる。そのため，痰の吸引時には，気管内に溜まった痰 力 痰吸引口を略完全に塞ぐ前に若干でも気管側の口の形成壁に接触すると，痰は その壁面に沿って広がって行く。もちろん，このときには痰の一部が痰吸引口の方向 へも移動する。その結果，呼吸路の気管側の口と通し孔の気管側の口とが呼吸路の 長さ方向に直交する同一平面内に配置された従来の気管力ニューレに比べて，痰 吸引口が閉塞され易くなる。これにより，気管内の痰の発生量が従来のときょり少なく ても，痰の確実な吸引が可能となり，気管内の痰を早期に吸引することができる。す なわち，痰の発生に対する気管力-ユーレの応答性を高めることができる。  [0012] In the tracheal force-yure according to the present invention, it is preferable that the suction port in the suction path of the sputum is arranged on the cuff side with respect to the tracheal side port provided at the distal end portion of the respiratory path. It is. In this case, there is a mouth-forming wall on the trachea side of the respiratory tract ahead of the tracheal force-Yule from the sputum suction port. For this reason, when sputum is sucked, the sputum collected in the trachea. If the sputum touches the formation wall of the mouth on the trachea side before the suction port is almost completely closed, the spider spreads along the wall surface. Of course, at this time, part of the soot also moves in the direction of the soot suction port. As a result, compared with the conventional tracheal force neuret where the tracheal side mouth of the respiratory tract and the tracheal side mouth of the through hole are arranged in the same plane perpendicular to the length direction of the respiratory tract, the 痰 suction port is blocked. It becomes easy to be done. As a result, even if the amount of soot generated in the trachea is less than in the past, the soot can be reliably suctioned and the soot in the trachea can be sucked in early. In other words, the response of tracheal force-yure to the occurrence of sputum can be improved.
[0013] 本発明に係る気管力-ユーレにおいて，呼吸路及び吸引路の間に位置する隔壁に ,これら両者を連通する別の痰の吸引口が設けられている構成とするのが好適であ る。この場合，痰の吸引路と気管とを直接連通する痰吸引口が気管内壁に密接状態 で痰を吸引（空吸引）しても，この力ニューレ本体の先端部の痰吸引口に気管内壁の 一部分が吸い付いてしまうことがない。これは，痰の吸引路における呼吸路側の隔壁 に，あた力もリリーフ弁のような機能を果たす別の痰吸引口が存在するためである。な お，痰の吸引時において，隔壁に形成された痰吸引口は，吸引路における気管内壁 側の壁に形成された痰吸引口より痰が吸引路に流入した際，吸引路内で痰の膜が 発生することにより塞がれる。その結果，隔壁に痰吸引口を形成したことにより，気管 内壁側の痰吸引ロカもの痰の吸引力が低下することはない。また，人工呼吸器によ る排気時には，気管力ニューレの呼吸路に痰が流れ込み，円滑な呼吸を妨げること が懸念されるが，気管力ニューレの呼吸路の先端付近に存在する痰は，痰の吸引路 の先端に有する隔壁側の痰吸引口により吸引されるため，痰が呼吸路に流れ込んで もこれを速やかに除去することができ，円滑な呼吸に支障を来す恐れは実質的に皆 無である。 [0013] In the tracheal force-yure according to the present invention, it is preferable that the septum located between the respiratory path and the suction path is provided with another sputum suction port that communicates both of them. The In this case, even if the soot suction port that directly communicates the soot suction path and the trachea is sucked into the trachea inner wall and sucks soot (empty suction), the trachea inner wall is connected to the soot suction port at the tip of this force neuron body. Part will not stick. This is because there is another sputum suction port that acts as a relief valve in the septum on the breathing path side of the sputum suction path. When suctioning the soot, the soot suction port formed in the partition wall is the inner wall of the trachea in the suction path. When soot flows into the suction path from the soot suction port formed on the side wall, it is blocked by the formation of a soot film in the suction path. As a result, the suction force of the soot suction loci on the inner wall of the trachea is not reduced by forming the soot suction port in the partition wall. In addition, when ventilating with a ventilator, there is a concern that soot may flow into the respiratory tract of the tracheal force neure and hinder smooth breathing. Since the suction is performed by the septum-side sputum suction port at the tip of the suction path, even if the sputum flows into the breathing path, it can be removed quickly, and there is virtually no risk of hindering smooth breathing. None.
[0014] 本発明に係る気管力-ユーレにおいて，痰の吸引路の先端部は密閉された構成と し，又は開口して気管に連通可能とした構成とすることができる。また，呼吸路及び吸 引路の間の隔壁の一部を力-ユーレ本体の先端部よりも基端部側で終止させて呼吸 路及び吸引路の各先端部を互いに連通させる連通空間を形成し，該連通空間を気 管に連通可能とした構成とすることもできる。  [0014] In the tracheal force-yure according to the present invention, the tip of the suction path of the sputum may be configured to be sealed, or may be configured to be open and communicated with the trachea. In addition, a part of the partition wall between the breathing path and the suction path is terminated at the base end side from the distal end of the force-yure body to form a communication space in which the distal ends of the breathing path and the suction path communicate with each other. The communication space can be configured to be able to communicate with the trachea.
[0015] 以下，本発明を図示の好適な実施形態について更に詳述する。  Hereinafter, the present invention will be described in further detail with reference to preferred embodiments shown in the drawings.
図面の簡単な説明  Brief Description of Drawings
[0016] [図 1]図 1は，本発明の気管力-ユーレを適用した人工呼吸システムを示す斜視図で ある。  [0016] FIG. 1 is a perspective view showing an artificial respiration system to which the tracheal force-ule of the present invention is applied.
[図 2]図 2a及び 2bは，それぞれ本発明の第 1実施例に係る気管力-ユーレの縦断面 及び横断面を示す略図である。  [FIG. 2] FIGS. 2a and 2b are schematic views respectively showing a longitudinal section and a transverse section of the tracheal force-yure according to the first embodiment of the present invention.
[図 3]図 3は，第 1実施例に係る気管力ニューレの変形例を示す，図 2bと同様な略図 である。  [FIG. 3] FIG. 3 is a schematic view similar to FIG. 2b, showing a modified example of the tracheal force neuule according to the first embodiment.
[図 4]図 4a及び 4bは，それぞれ本発明の第 2実施例に係る気管力-ユーレの縦断面 及び横断面を示す略図である。  [FIG. 4] FIGS. 4a and 4b are schematic views showing a longitudinal section and a transverse section of a tracheal force-yure according to a second embodiment of the present invention, respectively.
[図 5]図 5a, 5b, 5c及び 5dは，それぞれ第 2実施例に係る気管力-ユーレの痰吸引動 作を示す略図である。  [FIG. 5] FIGS. 5a, 5b, 5c and 5d are schematic diagrams showing the tracheal force-yure sputum suction operation according to the second embodiment, respectively.
[図 6]図 6は，本発明の第 3実施例に係る気管力ニューレの痰吸引動作を示す略図で ある。  [FIG. 6] FIG. 6 is a schematic diagram showing a sputum suction operation of a tracheal force neuron according to a third embodiment of the present invention.
[図 7]図 7は，本発明の第 4実施例に係る気管力ニューレの痰吸引動作を示す略図で ある。 [FIG. 7] FIG. 7 is a schematic diagram showing the sputum suction operation of the tracheal force neurale according to the fourth embodiment of the present invention. is there.
[図 8]図 8は，本発明の第 5実施例に係る気管力ニューレの痰吸引動作を示す略図で ある。  [FIG. 8] FIG. 8 is a schematic view showing a sputum suction operation of a tracheal force neuron according to a fifth embodiment of the present invention.
発明を実施するための最良の形態  BEST MODE FOR CARRYING OUT THE INVENTION
[0017] 図 1において，参照数字 10は本発明の第 1実施例に係る気管力-ユーレ 14を適用し た人工呼吸システム全体を表わしている。人工呼吸システム 10は，送気及び排気を 行う呼吸管 11が連通 ·接続された人工呼吸器 12と，患者の切開された気管 13に挿入 される気管力-ユーレ 14と，気管 13内に溜まった痰を吸い出すための吸引チューブ 1 5が連通された痰吸引器 16と，痰の収集ビン 17とを具えている。また，人工呼吸システ ム 10は，シーケンサやタイマ等が配設された制御部（コントロールボックス） 18を具え， 吸引チューブ 15の内圧に応じて痰吸引器 16による吸引圧を調整して痰吸引器 16に 対する流入量を制御するものである。  In FIG. 1, reference numeral 10 represents the whole artificial respiration system to which the tracheal force-urere 14 according to the first embodiment of the present invention is applied. The artificial respiration system 10 includes a ventilator 12 to which a respiratory tube 11 for supplying and exhausting air is connected and connected, a tracheal force-urele 14 inserted into a trachea 13 incised by a patient, and a respiratory tube 13 accumulated in the trachea 13. A suction tube 15 is connected to a suction tube 15 for sucking out the soot, and a soot collection bottle 17 is provided. In addition, the artificial respiration system 10 includes a control unit (control box) 18 in which a sequencer, a timer, and the like are arranged, and adjusts the suction pressure by the heel suction device 16 according to the internal pressure of the suction tube 15 to adjust the suction device. This controls the amount of inflow to 16.
[0018] 人工呼吸器 12は，内蔵した吸引器及びコンプレッサを一定時間毎に交互に作動さ せて患者の呼吸を確保する，それ自体は既知の構成とされている。すなわち，呼吸 管 11は，人工呼吸器 12の送排気口と，気管力-ユーレ 14の基端部に装着されたマウ ント (ジョイント部） 20とを連通している。また，呼吸管 11の中間部には，呼気弁 21が設 けられている。  [0018] The ventilator 12 has a known configuration in which a built-in aspirator and a compressor are alternately operated at regular intervals to ensure patient respiration. In other words, the respiratory tube 11 communicates the air supply / exhaust port of the ventilator 12 with the mount (joint) 20 attached to the proximal end of the tracheal force-urele 14. An exhalation valve 21 is provided in the middle of the respiratory tube 11.
[0019] 気管力-ユーレ 14の力-ユーレ本体 14Aは，略 J字形状に湾曲した所定長さのブラ スチック管で構成されており，気管切開手術により患者の気管 13に形成された孔を通 して気管 13内に挿入される。力ニューレ本体 14Aは，内径が例えば 8〜12 mmの円形 断面を有し，内部に呼吸路 14aが形成され，先端が患者の気管内に開口するもので ある。  [0019] Tracheal force-Force of Yule 14-Yule body 14A is composed of a plastic tube of a predetermined length curved in a substantially J-shape, and has a hole formed in the trachea 13 of the patient by tracheostomy surgery. It is inserted into the trachea 13 through. The force neuron body 14A has a circular cross section with an inner diameter of, for example, 8 to 12 mm, has a respiratory passage 14a formed therein, and the tip opens into the patient's trachea.
[0020] 力-ユーレ本体 14Aの先端部の外周側には，空気の出し入れによって膨張，収縮さ せるカフ 32が，本体 14Aの外周に密着して環状に配設されている。カフ 32は，合成榭 脂シートからなる環状のバルーンである。力-ユーレ本体 14Aの外周側には，カフ 32 に空気を注入する合成樹脂製の細管 32aが固着されている。細管 32aの基端部には ,弁付きの小さな円筒状アダプタ 33が設けられている。このアダプタ 33にシリンジ先 端を差し込み，シリンジによって細管 32aから空気をカフ 32に注入すると，カフ 32が膨 張するものである。 [0020] On the outer peripheral side of the tip portion of the force-urele main body 14A, a cuff 32 that is expanded and contracted by taking in and out air is arranged in an annular shape in close contact with the outer periphery of the main body 14A. Cuff 32 is an annular balloon made of a synthetic resin sheet. A thin tube 32a made of synthetic resin that injects air into the cuff 32 is fixed to the outer peripheral side of the force-yure body 14A. A small cylindrical adapter 33 with a valve is provided at the proximal end of the thin tube 32a. When the tip of the syringe is inserted into this adapter 33 and air is injected into the cuff 32 from the narrow tube 32a by the syringe, the cuff 32 is inflated. It is something to be stretched.
[0021] 図 2a及び 2bに示すように，略円筒形状の力-ユーレ本体 14Aの内部空間には，上 述した呼吸路 14aと，この呼吸路 14aの一側に配置される痰の吸引路 14bとが，隔壁 14 0で分けられて各別に設けられている。すなわち，力ニューレ本体 14Aの内部は，隔 壁 140により，大きな断面積の呼吸路 14aと，これよりも小さな断面積の略半月形状の 吸引路 14bとに分離されている。呼吸路 14aの外周における痰の吸引路 14bの形成位 置は，略 J字形状に湾曲した力-ユーレ本体 14Aの外周壁のうち，湾曲中心とは反対 側に位置する部位である。言い換えれば，仰向けに寝た患者に対して気管力ニュー レ 14を正規に挿着した際，患者の下側 (背中側）となる部位に痰の吸引路 14bが J字 の湾曲に沿って配置されるものである。力-ユーレ本体 14Aの管壁を厚肉化して，痰 の吸引路 14bを管壁内に形成することもできる。この場合には，管壁の呼吸路側が呼 吸路 14aと吸引路 14bとの間の隔壁として機能する。なお，痰の吸引路 14bの先端部 における下面には，例えば楕円形の痰吸引口 14cが形成されている。  [0021] As shown in FIGS. 2a and 2b, the internal space of the substantially cylindrical force-urele body 14A includes the above-described respiratory path 14a and the suction path of the sputum disposed on one side of the respiratory path 14a. 14b is divided by the partition 140 and provided separately. In other words, the inside of the force neuron main body 14A is separated by the partition wall 140 into a breathing path 14a having a large cross-sectional area and a substantially half-moon shaped suction path 14b having a smaller cross-sectional area. The position where the sputum suction path 14b is formed on the outer periphery of the respiratory path 14a is a portion of the outer wall of the force-urele body 14A curved in a substantially J shape that is located on the opposite side of the center of curvature. In other words, when the tracheal force neuron 14 is properly inserted into a patient who lies on his back, the suction path 14b of the heel is placed along the J-shaped curve at the lower (back) side of the patient. It is what is done. It is also possible to increase the thickness of the tube wall of the force-yure body 14A and form a soot suction path 14b in the tube wall. In this case, the breathing path side of the tube wall functions as a partition between the breathing path 14a and the suction path 14b. For example, an elliptical spear suction port 14c is formed on the lower surface of the tip of the spear suction path 14b.
[0022] さらに，呼吸路 14aの先端には，気管側の口 14dが形成されている。この口 14dを介 して気管内と人工呼吸器 12の呼吸管 11とが連通している。痰の吸引路 14bは，その 先端が封止されている。痰の吸引路 14bは，その先端の痰吸引口 14cを介して痰の吸 引を行うものである。なお，痰の吸引口 14cの形状は楕円形に限定されるものでなく， 例えば所定の幅及び長さを有するスリット状でもよい。  Furthermore, a trachea side mouth 14d is formed at the tip of the respiratory path 14a. The inside of the trachea communicates with the respiratory tube 11 of the ventilator 12 through the mouth 14d. The tip of the soot suction path 14b is sealed. The soot suction path 14b performs soot suction through the soot suction port 14c at the tip. The shape of the spout suction port 14c is not limited to an ellipse, and may be, for example, a slit having a predetermined width and length.
[0023] 気管力-ユーレ 14の力-ユーレ本体 14Aの基端部には，マウント 20を迂回して痰吸 引器 16から延出された吸引チューブ 15の先端部が連通されている。吸引チューブ 15 の外径は，例えば 4 mmである。  The distal end portion of the suction tube 15 extending from the suction suction device 16 bypassing the mount 20 is communicated with the proximal end portion of the trachea force—the force of the urea 14 and the urea body 14A. The outer diameter of the suction tube 15 is 4 mm, for example.
[0024] 痰の吸引路 14bは，呼吸路 14aとの仕切り用の隔壁 140が平坦で，かつその長さ方 向に直交する断面が図 2bに例示するように半月形状を呈する通路である。図 3は，吸 引路 14bの断面形状を円形状とした変形例を示す。吸引路 14bの断面形状は上記以 外の形状，例えば楕円状とすることも可能である。いずれの場合にも吸引路 14bは， 力-ユーレ本体 14Aの湾曲に沿って，その湾曲凸側に形成されている。この湾曲した 凸側が，仰向けに寝た患者の気管への装着時に気管底部内壁に近接又は密着可 能となり，その反対側の凹側は気管底部内壁力 離間する。上述したとおり，呼吸路 14aの断面積は吸引路 14bのそれよりも大きい。これにより，患者は楽に呼吸すること ができる。 [0024] The sputum suction passage 14b is a passage that has a flat partition wall 140 for partitioning with the respiratory passage 14a and a half-moon shape whose cross section perpendicular to the length direction is illustrated in FIG. 2b. Figure 3 shows a modification in which the cross-sectional shape of the suction path 14b is circular. The cross-sectional shape of the suction path 14b may be other than the above, for example, an ellipse. In any case, the suction path 14b is formed on the curved convex side along the curve of the force-urele main body 14A. This curved convex side becomes close to or close to the inner wall of the tracheal floor when attached to the trachea of a patient lying on his back, and the opposite concave side separates the inner wall force of the tracheal floor. As mentioned above, the respiratory tract The cross-sectional area of 14a is larger than that of the suction channel 14b. This allows the patient to breathe comfortably.
[0025] 図 1に示すように，吸引チューブ 15は，可撓性を有する合成樹脂製の細長い弾性 チューブである。吸引チューブ 15の長さ方向の中間部より上流側 (気管力-ユーレ 14 側）には，痰吸引器 16による吸引圧を検出する際に利用される短尺な分岐管 30が連 通されている。分岐管 30は，その先端部（図 1では上端部)で圧力センサ 31に連通さ れている。圧力センサ 31により吸引路 14bの内圧（すなわち，吸引路 14b内における痰 の吸引圧)を測定することができる。  [0025] As shown in FIG. 1, the suction tube 15 is a flexible elastic thin elastic tube. A short branch pipe 30 used for detecting suction pressure by the soot suction device 16 is connected to the upstream side (tracheal force-Yure 14 side) of the middle portion of the suction tube 15 in the length direction. . The branch pipe 30 communicates with the pressure sensor 31 at its tip (upper end in Fig. 1). The pressure sensor 31 can measure the internal pressure of the suction path 14b (that is, the suction pressure of soot in the suction path 14b).
[0026] 痰吸引器 16は，その内部で発生させた負圧により，気管 13内に溜まった痰を痰吸 引路 14b及び吸引チューブ 15を介して吸い出し，収集ビン 17に回収するものである。 図 1に示すように，痰吸引器 16は適宜のポンプ，例えばチューブポンプ 16Aを具えて いる。チューブポンプ 16Aは，所定の弾性力を有する合成樹脂製の吸引チューブ 15 を局所的に押圧して閉塞させる 3つの押圧ローラが，外周上で円周方向に離間した 位置にそれぞれ突設されたロー夕と，ロータの外周面力も所定距離だけ離間して設 けられ，ロータとの対向面が，このロータの外周面と平行に湾曲したチューブ押圧面 として構成された押圧ガイドと，ロータを回転させる回転手段とを含んでいる。ロータ の回転手段は電動モータ 52で構成され，押圧ガイドのチューブ押圧面に沿ってロー タを回転させる。チューブポンプ 16Aによる痰の圧送量（圧送速度）は， 50〜200cc/se cを目安とする。  The soot suction unit 16 sucks out the soot accumulated in the trachea 13 through the soot suction path 14b and the suction tube 15 due to the negative pressure generated therein, and collects it in the collection bottle 17. As shown in Fig. 1, the sputum suction device 16 includes an appropriate pump, for example, a tube pump 16A. The tube pump 16A has three pressure rollers that locally press and close a suction tube 15 made of a synthetic resin having a predetermined elastic force and projecting at positions spaced apart in the circumferential direction on the outer periphery. In the evening, the outer peripheral surface force of the rotor is also set apart by a predetermined distance, and the surface facing the rotor is configured as a tube pressing surface curved parallel to the outer peripheral surface of the rotor, and the rotor is rotated. And rotating means. The rotating means of the rotor consists of an electric motor 52, which rotates the rotor along the tube pressing surface of the pressing guide. The standard feed rate (pumping speed) for soot by tube pump 16A is 50 to 200cc / sec.
[0027] 制御部 18は，次のように痰の吸引動作を制御する。すなわち，通常の痰吸引時に は，チューブポンプ 16Aを予め設定した設定値 (痰吸引時の正常な吸引圧)で作動さ せ，圧力センサ 31により検出された検出値がその設定値より高くなつた時，チューブ ポンプ 16Aに対して作動指令を出してポンプ出力を所定時間だけ高める。すなわち， 痰吸引器 16の通常運転中はチューブポンプ 16Aを常時作動させ，吸引チューブ 15 内で痰が詰まるなどの異常状態が発生した場合には，チューブポンプ 16Aの出力を 高めて対処するものである。なお，上述したような異常事態の発生に備えて，痰吸引 器 16に制御部 18で制御される補助ポンプ，例えばダイヤフラム式ポンプを併設して おくことちでさる。 [0028] 第 1実施例に係る気管力-ユーレ 14が適用された自動吸引システム 10の作動を説 明すれば，次のとおりである。 [0027] The control unit 18 controls the suction operation of the soot as follows. In other words, during normal soot suction, the tube pump 16A is operated at a preset value (normal suction pressure during soot suction), and the detection value detected by the pressure sensor 31 becomes higher than the set value. At this time, an operation command is issued to the tube pump 16A to increase the pump output for a predetermined time. In other words, the tube pump 16A is always operated during normal operation of the soot suction device 16, and if an abnormal condition such as clogging occurs in the suction tube 15, the output of the tube pump 16A is increased to deal with it. is there. In preparation for the occurrence of an abnormal situation as described above, an auxiliary pump controlled by the control unit 18, such as a diaphragm pump, is provided in addition to the soot suction device 16. [0028] The operation of the automatic suction system 10 to which the tracheal force-Yure 14 according to the first embodiment is applied will be described as follows.
[0029] 先ず，切開された患者の気管 13に気管力-ユーレ 14の力-ユーレ本体 14Aの先端 部を挿入する。この場合，所定の曲率で湾曲した力-ユーレ本体 14Aの湾曲凸部が 下側となって気管内壁に対向する状態となる。次に，シリンジによってカフ 32に空気 を注入し，これを膨らませる。その結果，力-ユーレ本体 14Aの周壁と気管内壁との隙 間がカフ 32により閉塞される。その後，力-ユーレ本体 14Aの基端部に，人工呼吸器 1 2から延出された呼吸管 11を連通させる。患者の呼吸，すなわち人工呼吸器 12を用 いた患者の気管 13への送気および排気は，従来と同様に，呼吸管 11およびマウント 2 0を介して，力-ユーレ本体 14A内の呼吸路 14aを通して行われる。  [0029] First, the tracheal force—the force of the urea 14—the tip of the urea body 14A is inserted into the trachea 13 of the incised patient. In this case, the force curved with a predetermined curvature—the curved convex portion of the Eurel main body 14A is on the lower side and faces the inner wall of the trachea. Next, inject air into the cuff 32 with a syringe and inflate it. As a result, the gap between the peripheral wall of the force-yure body 14A and the inner wall of the trachea is closed by the cuff 32. Thereafter, the respiratory tube 11 extended from the ventilator 12 is communicated with the proximal end of the force-yure body 14A. The patient's breathing, that is, the air supply and exhaust to the patient's trachea 13 using the ventilator 12 is performed through the respiratory tube 11 and the mount 20 as before, and the respiratory path 14a in the force-urere body 14A. Done through.
[0030] 患者の気管 13内に痰 phが溜まった際には，吸引チューブ 15を介して，痰の吸引路 14bと連通されたチューブポンプ 16Aを作動させる。その結果，ポンプ 16A内で発生し た負圧により痰が，痰吸引口 14cより吸引路 14b内に吸引され，吸引路 14b及び吸引 チューブ 15を通して体外に吸い出される。呼吸路 14aは人工呼吸器 12と常時連通さ れているので，痰の吸引中でも呼吸は確保される。なお，チューブポンプ 16Aによる 痰の吸引作用にっ ヽては後述する。  When sputum ph accumulates in the trachea 13 of the patient, the tube pump 16A communicated with the sputum suction path 14b is operated via the suction tube 15. As a result, soot is sucked into the suction path 14b through the suction port 14c and sucked out of the body through the suction path 14b and the suction tube 15 due to the negative pressure generated in the pump 16A. Since the respiratory path 14a is always in communication with the ventilator 12, respiration is ensured even during sputum suction. The soot suction action by tube pump 16A will be described later.
[0031] 痰の吸引路 14bは，先端が閉鎖されている。そして，痰吸引口 14cは，呼吸路 14aの 気管側の口 14dよりもカフ 32側に配置されている。すなわち，痰吸引口 14cは，従来の ように気管内壁に直交して開口されているのではなく，気管内壁と平行に対峠して開 口されており，呼吸路 14aにおける気管側の口 14dの形成壁は痰吸引口 14cよりも気 管力-ユーレ 14の先方側に露出することになる。これにより，痰吸引時には，気管 13 内に溜まった痰が，気管力-ユーレ 14の痰吸引口 14cを略完全に塞ぐ前に，若干でも 気管側の口 14dの形成壁に接触すると，痰はその壁面に沿って広がって行く。もちろ ん，その際には，痰の一部が痰吸引口 14cの方向へも移動する。その結果，従来の 気管力-ユーレに比べて，痰吸引口 14cが閉塞され易くなる。これにより，気管 13内に 発生する痰が比較的少量であって，従来技術では痰の吸引が実質的に行えない場 合でも，痰を的確に吸引することができる。すなわち，本発明によれば，気管 13内の 痰を早期に吸引することができ，痰の発生に対する気管力ニューレ 14の応答性を高 めることができる。 [0031] The tip of the soot suction path 14b is closed. The sputum suction port 14c is arranged on the cuff 32 side of the trachea side port 14d of the respiratory path 14a. That is, the sputum suction port 14c is not opened perpendicularly to the tracheal inner wall as in the prior art, but is opened in parallel with the tracheal inner wall, and the tracheal side port 14d in the respiratory tract 14a. The formation wall is exposed to the front side of the trachea-urele 14 rather than the sputum suction port 14c. As a result, when the soot collected in the trachea 13 contacts the formation wall of the tracheal side mouth 14d even before it almost completely closes the soot suction port 14c of the trachea-yure 14, It spreads along the wall. Of course, part of the soot also moves in the direction of the soot suction port 14c. As a result, the sputum suction port 14c is more easily clogged than the conventional tracheal force-Yure. As a result, even if the amount of soot generated in the trachea 13 is relatively small, soot can be sucked accurately even if the conventional technology cannot practically suck the soot. That is, according to the present invention, the soot in the trachea 13 can be sucked at an early stage, and the response of the tracheal force nucleus 14 to the generation of soot is enhanced. You can
[0032] 次に，チューブポンプ 16Aによる具体的な痰の吸引作用について説明する。先ず， ロータの外周面と押圧ガイドのチューブ押圧面との間に吸引チューブ 15を配置させ た状態で，回転手段 52よりロータを痰排出側に回転させる。これにより，押圧ローラが 押圧ガイドのチューブ押圧面に沿って痰の排出側に回転し，押圧ガイドのチューブ 押圧面側と押圧ローラとの間で吸引チューブ 15の一部が閉塞される。その閉塞位置 は，押圧ローラの回転に伴って痰の排出側に連続的に移動する。その結果，吸引チ ユーブ 15上での閉塞位置が痰の排出側に徐々に移行し，吸引チューブ 15の吸引側 で負圧が発生して気管 13内の痰を，痰吸引口 14c及び吸引路 14bを経て吸引チュー ブ 15に吸い込むと共に，吸引チューブ 15内の痰を次第に排出側に圧送し，最終的に 吸引チューブ 15から排出する。その結果，簡単でかつ低コストな構造により痰吸引器 16を得ることができる。  [0032] Next, the specific soot suction action by the tube pump 16A will be described. First, in a state where the suction tube 15 is disposed between the outer peripheral surface of the rotor and the tube pressing surface of the pressing guide, the rotor is rotated from the rotating means 52 to the soot discharge side. As a result, the pressing roller rotates along the tube pressing surface of the pressing guide toward the discharge side of the bag, and a part of the suction tube 15 is blocked between the pressing surface side of the pressing guide and the pressing roller. The closed position moves continuously to the side of the soot discharge as the pressing roller rotates. As a result, the blocking position on the suction tube 15 gradually shifts to the soot discharge side, and negative pressure is generated on the suction side of the suction tube 15 so that the soot in the trachea 13 is removed from the soot suction port 14c and the suction path. While sucking into the suction tube 15 through 14b, the soot in the suction tube 15 is gradually pumped to the discharge side and finally discharged from the suction tube 15. As a result, the soot suction device 16 can be obtained with a simple and low-cost structure.
[0033] また，痰の吸引路 14bの痰吸引口 14cが痰などで塞がれていない状態ではチューブ 内圧は高まらず，痰吸引口 14cが痰などによって塞がれた時，はじめてチューブボン プ 16Aによる吸引圧が上昇を開始する。そのため，仮にカフ 32内の空気が抜けて，気 管 13内に留置した吸引チューブ 15の痰吸引口 14cが気管内壁に接触した場合には 吸引圧が上昇しないので，気管内壁の一部分が痰の吸引路 14bに吸い込まれること がなく，気管内壁を傷つける恐れは実質的に皆無である。しかも，常時定量で吸引し て!、ることで，圧力センサ 31により痰の有無を確実かつ即座に検出することができる。  [0033] In addition, when the soot suction port 14c of the soot suction path 14b is not blocked by soot or the like, the internal pressure of the tube does not increase. When the soot suction port 14c is closed by soot or the like, the tube pump is not used for the first time. The suction pressure by 16A starts to rise. Therefore, if the air in the cuff 32 escapes and the suction port 14c of the suction tube 15 placed in the trachea 13 comes into contact with the inner wall of the trachea, the suction pressure does not increase. It is not sucked into the suction channel 14b and there is virtually no risk of damaging the inner wall of the trachea. Moreover, by constantly sucking in a fixed amount !, the pressure sensor 31 can reliably and immediately detect the presence or absence of soot.
[0034] 通常運転時において，チューブポンプ 16Aにより処理できない程の多量の痰が発 生した場合や，高粘性の痰で吸引チューブ 15が詰まった場合には，吸引チューブ 15 の内圧が異常に高まる。それを圧力センサ 31が検知し，制御部 18からチューブボン プ 16Aに出力増加指令が出される。その結果，痰吸引中の異常事態を回避し，気管 閉塞事故などを未然に防止することができる。  [0034] During normal operation, if so much soot that the tube pump 16A cannot handle is generated, or if the suction tube 15 is clogged with highly viscous soot, the internal pressure of the suction tube 15 increases abnormally. . The pressure sensor 31 detects this, and the controller 18 issues an output increase command to the tube pump 16A. As a result, it is possible to avoid abnormal situations during sputum suction and prevent accidents such as tracheal obstruction.
[0035] 図 4a及び 4bは本発明の第 2実施例に係る気管力-ユーレを示すものである。本例 に係る気管力-ユーレは，前述した第 1実施例によるものと基本的に同一の構成を有 しており，相違点は，痰の吸引路 14bにおける痰吸引口 14cとは反対側の上面に相当 する部位で，ほぼ同じサイズの別の痰吸引口 14eが隔壁 140に追カ卩的に形成されて いる点である。痰吸引口 14eは，気管力-ユーレ 14における呼吸路 14aの先端部に開 口 ·連通している。 [0035] FIGS. 4a and 4b show the tracheal force-yure according to the second embodiment of the present invention. The tracheal force-Yule according to this example has basically the same configuration as that of the first example described above, and the difference is that the side opposite to the sputum suction port 14c in the sputum suction path 14b is the same. Another soot suction port 14e of approximately the same size is formed on the partition wall 140 in a portion corresponding to the upper surface. It is a point. The sputum suction port 14e opens and communicates with the distal end of the respiratory path 14a in the tracheal force-urere 14.
[0036] 患者の気管 13内に痰 phが溜まった際には，第 1実施例におけると同様にチューブ ポンプ 16Aを作動させる。その結果，ポンプ 16A内で発生した負圧により痰は痰吸引 口 14cより吸引路 14b内に吸引され，吸引路 14b及び吸引チューブ 15を通して体外に 吸い出される。痰は痰吸引口 14c, 14eより吸引路 14bに吸引される。すなわち，気管 1 3内壁の痰のみならず，力-ユーレ本体 14A内の痰についても同時的に吸引されるこ ととなる。  [0036] When soot accumulates in the trachea 13 of the patient, the tube pump 16A is operated as in the first embodiment. As a result, the negative pressure generated in the pump 16A causes the soot to be sucked into the suction path 14b from the sputum suction port 14c, and then sucked out of the body through the suction path 14b and the suction tube 15. The soot is sucked into the suction path 14b from the soot suction ports 14c and 14e. In other words, not only the soot on the inner wall of the trachea 13 but also the soot in the force-yure main body 14A is sucked simultaneously.
[0037] 図 5aは，痰 phが気管内に存在しない状態を示す。このとき，気管内壁に下側の痰 吸引口 14cは密着するが，上側の痰吸引口 14eが開放されているため，下側の痰吸 引口 14cが気管内壁に吸い付いて完全にこの痰吸引口 14cを閉塞してしまうことがな く，気管内壁が吸引口 14cから吸引されることはない。  [0037] FIG. 5a shows a state where no ph is present in the trachea. At this time, the lower soot suction port 14c is in close contact with the inner wall of the trachea, but since the upper soot suction port 14e is open, the lower soot suction port 14c is attracted to the tracheal inner wall and completely removed. The suction port 14c is not blocked, and the inner wall of the trachea is not sucked from the suction port 14c.
[0038] 図 5b及び 5cは痰 phが気管内に存在する場合の作動を示す。このように痰は痰吸引 口 14cから吸引路 14b内に吸い込まれる。このとき，上側の痰吸引口 14eは薄い膜で 覆われる。図 5dは，気管力-ユーレ 14の呼吸路 14a内に痰が入り込んだ場合の吸引 作用を説明するものである。図 5dに示すように，呼吸路 14a内の痰は，上側の痰吸引 口 14eから吸引されることとなる。このとき，呼吸路 14aは人工呼吸器 12と常時連通され ているので，痰の吸引中でも呼吸は確保されている。  [0038] Figures 5b and 5c show the operation when ph is present in the trachea. In this way, soot is sucked into the suction path 14b from the soot suction port 14c. At this time, the upper soot suction port 14e is covered with a thin film. Fig. 5d illustrates the aspiration action when sputum enters the respiratory path 14a of the tracheal force-Yule 14. As shown in Fig. 5d, sputum in the respiratory path 14a is sucked from the upper sputum suction port 14e. At this time, since the respiratory path 14a is in constant communication with the ventilator 12, respiration is secured even during sputum suction.
[0039] 痰の吸引時，気管内壁側の壁の痰吸引口 14cが，仮に気管内壁に密接した状態で 空吸引したとしても，痰吸引口 14cに気管内壁の一部分が吸い付いてしまう恐れは実 質的に皆無である。それは，痰の吸引路 14bにおける呼吸路 14a側の壁に別の痰吸 引口 14eが存在するためである。すなわち，痰の吸引時，この別の痰吸引口 14eがリリ ーフ弁と同等の役割を果たし，仮に気管内壁側の壁の痰吸引口 14cが気管内壁に密 着したとしても，これを原因として別の痰吸引口 14e内に過剰の負圧力が作用するこ とはない。  [0039] During suction of sputum, even if sputum suction port 14c on the side wall of the trachea is idled in close contact with the inner wall of the trachea, there is a risk that a part of the inner wall of the trachea will stick to sputum suction port 14c. There is virtually nothing. This is because there is another sputum suction port 14e on the wall on the breathing path 14a side of the sputum suction path 14b. That is, when soot is sucked, this other soot suction port 14e plays the same role as the relief valve, and even if the soot suction port 14c on the inner wall of the trachea is closely attached to the inner wall of the trachea, As a result, excessive negative pressure does not act in another sputum suction port 14e.
[0040] ところで，痰 phの吸引時，痰吸引路 14bの呼吸路 14a側の隔壁 140に形成された痰 吸引口 14eは，痰が吸引路 14bに流入したとき，人工呼吸器 12による呼吸路 14a内で の空気の流れに誘発されて，吸引路 14bの先端部の内周面に沿って痰の膜が張られ る（発生する）ことにより塞がれる。その結果，痰吸引路 14bの呼吸路 14a側の壁に痰 吸引口 14eを形成したことで，痰の吸引力が大きく低下するという恐れは実質的に皆 無である（図 5b及び 5c)。このような有利な効果は，本発明者らにより初めて知見され たものである。 [0040] By the way, during suction of sputum ph, sputum suction port 14e formed in septum 140 on the breathing path 14a side of sputum suction path 14b is used as a respiratory path by ventilator 12 when sputum flows into suction path 14b. Induced by the air flow in 14a, a soot film is stretched along the inner peripheral surface of the tip of the suction channel 14b. It is blocked by (occurs). As a result, there is virtually no fear that the suction force of the sputum will be greatly reduced by forming the sputum suction port 14e on the breathing path 14a side wall of the sputum suction path 14b (Figs. 5b and 5c). Such advantageous effects have been discovered for the first time by the present inventors.
[0041] また，人工呼吸器 10の排気時に気管力-ユーレ 14の呼吸路 14bに痰が流れ込むと ,円滑な呼吸を妨げる懸念がある。し力しながら，吸引路 14b内の痰は，力ニューレ本 体壁に形成された痰吸引口 14eによって吸引される。そのため，痰が呼吸路 14aに流 れ込んでも，呼吸路 14aを介しての円滑な呼吸への支障は少ない（図 5d)。  [0041] In addition, when sputum flows into the respiratory path 14b of the tracheal force-urere 14 when the ventilator 10 is exhausted, there is a concern that smooth breathing may be hindered. While pushing, the soot in the suction channel 14b is sucked by the soot suction port 14e formed on the force nut body wall. Therefore, even if sputum flows into the respiratory path 14a, there are few obstacles to smooth breathing through the respiratory path 14a (Fig. 5d).
[0042] 図 6は，本発明に係る気管力-ユーレの第 3実施例を示すものである。本例は，気管 力-ユーレ 14の痰吸引路 14bの先端を開放したものである。したがって，力-ユーレ本 体 14Aよりも長さの短い (すなわち，先端側部分が切り欠かれて終結した)隔壁 140に より画成された呼吸路 14aと吸引路 14bとは，痰吸引路 14bの先端の開口部で連通し ている。この開口部が，第 2実施例における痰の吸引路 14eに相当することとなり，こ の開口部を介して力-ユーレ本体の呼吸路内に存在する痰をも吸引することができる 。また，この切り欠きに代えて，隔壁 140の先端に所定幅のスリットを所定長さだけ形 成してもよい。気管力-ユーレの装着時，このスリットにより上側の呼吸路 14aと下側の 痰の吸引路 14bとが連通されることとなる。  FIG. 6 shows a third embodiment of the tracheal force-yure according to the present invention. In this example, the tip of the sputum suction path 14b of the tracheal force-Yure 14 is opened. Therefore, the respiratory path 14a and the suction path 14b defined by the septum 140, which is shorter in length than the force-yure body 14A (that is, terminated by cutting off the front end portion), are the sputum suction path 14b. It communicates with the opening at the tip of the. This opening corresponds to the sputum suction path 14e in the second embodiment, and sputum existing in the breathing path of the force-yuree main body can also be sucked through this opening. In place of this notch, a slit having a predetermined width may be formed at the tip of the partition 140 by a predetermined length. When the tracheal force-Yule is attached, this slit allows the upper respiratory path 14a to communicate with the lower sputum suction path 14b.
[0043] このように構成した結果，図 6の実施例によれば，下側の痰吸引口 14cからの痰の吸 引は上記実施例のそれと同じであるが，その上側の痰吸引口（第 2実施例では痰吸 引口 14e)が大きく切り欠かれて開放されているため，または隔壁先端にスリットが形 成されているため，この開放部分 (すなわち，力-ユーレ本体 14Aの先端の口 14dと連 通した部分)から呼吸路 14a内の痰が吸引されることとなる。なお，隔壁先端にスリット を形成する方が，切り欠くよりもその作製が容易である。その他の構成および作用は 前述した実施例の場合と同様である。  [0043] As a result of the above configuration, according to the embodiment of Fig. 6, the suction of the soot from the lower soot suction port 14c is the same as that of the above embodiment, but the upper soot suction port ( In the second embodiment, the soot suction port 14e) is notched and opened, or a slit is formed at the end of the bulkhead. The sputum in the respiratory path 14a is sucked from the portion communicating with the mouth 14d). Note that it is easier to make a slit at the tip of the bulkhead than to cut it out. Other configurations and operations are the same as those in the above-described embodiment.
[0044] 図 7は，本発明に係る気管力-ユーレの第 4実施例を示すものである。本例は，気管 力-ユーレ 14の痰吸引路 14bの先端 (力-ユーレ本体 14Aの底部の一部分）を切り欠 いて開放したものである。隔壁 140により画成された呼吸路 14aと吸引路 14bとは，その 隔壁 140先端部に形成した痰吸引口 14eにより連通している。同時に，痰吸引路 14b の先端は，隔壁 140先端の下方にて開口又は開放されて気管内に連通している。こ の開口又は開放部 14c'が前述した実施例における痰の吸引路 14cに相当することと なり，この開口 14c'を介して力-ユーレ本体 14Aの外側の気管底部に存在する痰を 吸引することができる。なお，呼吸路 14aの先端開口 14dは，開口 14c'よりも力-ユー レ本体 14Aの長さ方向の先端側に位置している。 FIG. 7 shows a fourth embodiment of the tracheal force-yure according to the present invention. In this example, the tip of the trachea force-yure 14 sputum suction path 14b (force-a part of the bottom of the yule body 14A) is cut away and opened. The respiratory path 14a and the suction path 14b defined by the septum 140 communicate with each other through a sputum suction port 14e formed at the distal end of the septum 140. At the same time, sputum suction path 14b The tip of the tube opens or opens below the tip of the septum 140 and communicates with the trachea. This opening or opening 14c ′ corresponds to the soot suction path 14c in the above-described embodiment, and the soot existing at the bottom of the trachea outside the force-urele main body 14A is sucked through this opening 14c ′. be able to. Note that the distal end opening 14d of the respiratory path 14a is located closer to the distal end side in the length direction of the force-urel body 14A than the opening 14c '.
[0045] このように構成した結果，図 7の実施例によれば，上側の痰吸引用開口 14eからの 痰の吸引は上記実施例のそれと同じであるが，その下側の痰吸引用開口 14c'が大 きく切り欠かれて開放されているため，この開放部分 (すなわち，力-ユーレ本体 14A の先端部の外方に位置する気管と連通した部分)から気管内の痰が吸引されることと なる。その他の構成及び作用は前述した実施例の場合と同様である。  [0045] As a result of such a configuration, according to the embodiment of Fig. 7, the soot suction from the upper soot suction opening 14e is the same as that of the above embodiment, but the lower soot suction opening is Since 14c 'is greatly cut away and opened, soot in the trachea is aspirated from this open part (ie, the part communicating with the trachea located outside the tip of the force-urele body 14A) It will be. Other configurations and operations are the same as those in the above-described embodiment.
[0046] 図 8は，本発明に係る気管力-ユーレの第 5実施例を示すものである。本例は，気管 力ニューレ 14の痰吸引路 14bの先端を，呼吸路 14aの先端開口 14dと面一状態で開放 (開口 14g)したものである。隔壁 140により画成された呼吸路 14aと吸引路 14bとは，そ の隔壁 140先端部に形成した痰吸引口 14eにより連通している。同時に，痰の吸引路 14bの先端は，開口 14gにより気管内に連通している。この先端開口 14gとは別に，前 述した実施例におけると同様の痰吸引口 14cが，力-ユーレ本体 14Aのカフ 32よりも 先端側に形成されている。したがって，吸引器 16の作動により痰の吸引路 14bを負圧 とすると，痰吸引口 14eより呼吸路 14a内の痰を吸引することができると共に，開口 14g 及び痰吸引口 14cを介して力-ユーレ本体 14Aの外側の気管底部に存在する痰を吸 引することができる。  FIG. 8 shows a fifth embodiment of the tracheal force-yure according to the present invention. In this example, the tip of the sputum suction path 14b of the tracheal force neurale 14 is opened (opening 14g) flush with the tip opening 14d of the respiratory path 14a. The respiratory path 14a and the suction path 14b defined by the septum 140 communicate with each other through a sputum suction port 14e formed at the tip of the septum 140. At the same time, the tip of the sputum suction path 14b communicates with the trachea through the opening 14g. Apart from the tip opening 14g, a spear suction port 14c similar to that in the above-described embodiment is formed on the tip side of the cuff 32 of the force-urele main body 14A. Therefore, if the suction passage 14b of the sputum is made negative by the operation of the suction device 16, sputum in the respiratory passage 14a can be sucked from the sputum suction port 14e, and force-can be applied through the opening 14g and the sputum suction port 14c. Can absorb soot present at the bottom of the trachea outside the Eure body 14A.
[0047] このように構成した結果，図 8の実施例によれば，上側の痰吸引用開口 14eからの 痰の吸引は上記実施例のそれと同じであるが，その下側の痰吸引用口 14cの他に先 端開口 14gが設けられて 、るため，この開放部分 14gからも気管内の痰が吸引され， 気管内の痰を迅速に吸引することが可能である。その他の構成および作用は前述し た実施例の場合と同様である。  [0047] As a result of such a configuration, according to the embodiment of FIG. 8, the soot suction from the upper soot suction opening 14e is the same as that of the above embodiment, but the lower soot suction opening In addition to 14c, a leading end opening 14g is provided, so that the sputum in the trachea is also sucked from the open portion 14g, and the sputum in the trachea can be quickly sucked. Other configurations and operations are the same as those in the above-described embodiment.
[0048] 上述したところから明らかなとおり，本発明によれば，痰の発生後，早期に痰を吸引 することができ，痰吸引後における気管内での痰の残量を低減することができ，しか も呼吸路に入り込んだ痰を除去することができる気管力-ユーレを実現することが可 能である。なお，本発明に係る気管力ニューレが，気管切開手術により患者の気管途 中に形成された孔を通して気管に挿入される気管切開チューブのみならず，気管に 経口挿入される人工呼吸用力-ユーレにも同様に適用できることは，言うまでもない。 [0048] As is apparent from the above, according to the present invention, sputum can be sucked early after sputum generation, and the remaining amount of sputum in the trachea after sputum suction can be reduced. However, it is possible to achieve tracheal force-Yule that can remove sputum that has entered the respiratory tract. Noh. It should be noted that the tracheal force neuule according to the present invention is not limited to a tracheostomy tube inserted into the trachea through a hole formed in the tracheotomy of a patient by tracheostomy surgery, but also to a force for artificial respiration inserted into the trachea-Yule. It goes without saying that is equally applicable.

Claims

請求の範囲 The scope of the claims
[1] 外部の人工呼吸器力 延出された呼吸管を接続するための基端部と，患者の気管 内に挿入される先端部とを具え，  [1] External ventilator force It has a proximal end for connecting the extended respiratory duct and a distal end inserted into the patient's trachea.
該先端部の外周側に，空気の出し入れによって膨縮されるカフが周設され， 前記基端部と前記先端部との間に送気用及び排気用の呼吸路が設けられ，該呼 吸路の先端部に気管側の口が形成された気管力-ユーレであって，  A cuff that is inflated and contracted by air in and out is provided on the outer peripheral side of the distal end, and a breathing path for air supply and exhaust is provided between the base end and the distal end. Tracheal force-Yule with a tracheal mouth formed at the end of the tract,
患者の気管内に溜まった痰を吸引するための吸引路が前記呼吸路とは別に該呼 吸路に沿って設けられ，該吸引路の気管内壁側の壁が，該吸引路の先端部と前記 カフとの間の領域で痰の吸引口を有することを特徴とする気管力-ユーレ。  A suction path for sucking sputum accumulated in the patient's trachea is provided along the breathing path separately from the breathing path, and the wall on the tracheal inner wall side of the suction path is connected to the tip of the suction path. A tracheal force-yure having a spout suction port in a region between the cuff.
[2] 請求項 1記載の気管力ニューレにおいて，前記吸引口は，前記呼吸路の先端部に 設けられた気管側の口よりも前記カフ側に配置されていることを特徴とする気管力二 ユーレ。  [2] The tracheal force neuron according to claim 1, wherein the suction port is disposed closer to the cuff side than a tracheal side port provided at a distal end portion of the respiratory tract. Yule.
[3] 請求項 1記載の気管力ニューレにおいて，前記隔壁に，前記呼吸路及び前記吸引 路を連通する更なる痰の吸引口が設けられていることを特徴とする気管力-ユーレ。  [3] The tracheal force neure according to claim 1, wherein the partition is provided with a further sputum suction port communicating with the respiratory path and the suction path.
[4] 請求項 1記載の気管力ニューレにおいて，前記吸引路の先端部が密閉されている ことを特徴とする気管力ニューレ。  [4] The tracheal force neuron according to claim 1, wherein a tip of the suction path is sealed.
[5] 請求項 1記載の気管力ニューレにおいて，前記吸引路の先端部を開口して前記気 管に連通可能としたことを特徴とする気管力-ユーレ。  5. The tracheal force neuule according to claim 1, wherein the suction passage is opened to allow communication with the trachea.
[6] 請求項 1記載の気管力-ユーレにおいて，前記隔壁の一部を前記力-ユーレ本体 の先端部よりも基端部側で終止させて前記呼吸路及び前記吸引路の各先端部を互 いに連通させる連通空間を形成し，該連通空間を前記気管に連通可能としたことを 特徴とする気管力ニューレ。  [6] In the tracheal force-yure according to claim 1, a part of the partition wall is terminated closer to the proximal end side than the tip part of the force-yuree main body, and the distal ends of the respiratory path and the suction path are A tracheal force neurale characterized in that a communication space is formed to communicate with each other, and the communication space can communicate with the trachea.
PCT/JP2005/017742 2004-09-27 2005-09-27 Tracheal cannula WO2006035769A1 (en)

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